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    TMVR: What Is It?

    The heart is a sophisticated organ that pumps blood to all areas of your body. Heart valves are the gateways that ensure blood flows in the correct direction. Yet these structures could acquire defects compromising your heart health1. Earlier, people had to undergo high-risk surgery to prevent further deterioration of their ailing hearts. Fortunately, at present non-invasive cardiologists in Mumbai offer you much safer solutions like Transcatheter Mitral Valve Replacement (TMVR) to treat valvular defects.

    What Is TMVR?

    The mitral valve is one of the four main valves in your heart, located between the left atrium and left ventricle. Defects in these two chambers or the mitral valve itself cause improper movements in valve leaflets2. It could make the valve tight, leading to mitral stenosis or cause leakage leading to mitral regurgitation. Mitral regurgitation is the most common valvular disease in developed countries3. Even in developing nations like India, where rheumatic heart diseases contribute to most valvular lesions, the mitral valve remains the commonest valve affected4.
    Advancing technology has introduced Transcatheter Mitral Valve Replacement (TMVR) as a novel treatment for mitral valve stenosis or regurgitation. Here the dysfunctional mitral valve is replaced by a TMVR device without undergoing conventional open-heart surgery5.

    When To Go For TMVR?

    Opportunities for surgical interventions are generally limited among the aging population because of associated comorbidities, anatomical constraints, and elevated surgical risks6,7. Hence lesser invasive techniques like TMVR play a crucial role in treating valvular heart diseases in them.
    In a patient who is a candidate for surgical intervention, the treatment choice for dysfunctional mitral valve caused by valvular leaflet defects is the surgical valve repair8. Yet if the repair fails after some time, replacement becomes necessary. When mitral valve dysfunction occurs due to atrial or ventricular defects, usually the replacement is preferred rather than repair, as it provides more durable results.

    How Is It Done?

    Heart specialists may follow two different approaches to introduce the transcatheter valve2. In the first method, they insert the TMVR device via a trans-apical route by making a small incision on the chest to get direct access to the mitral valve location10. The second method is the trans-femoral approach which incorporates more improved technology to the first method. Here a skin incision is made to enter the femoral vein. The interventional cardiology specialist uses the patient’s vein as a pathway to direct a catheter and a guidewire towards the heart. Then punctures a specific point in the interatrial wall and places the TMVR device in the appropriate position. Cardiologists perform this while utilizing real-time imaging with echocardiography and fluoroscopy. This method is not only safe and effective but also has less morbidity and recovery time. It is also less invasive and much appealing to the patient and therefore more preferred today.

    Advantages Of TMVR

    It is a minimally invasive treatment for mitral valve defects and alleviates disastrous peri-operative risks and complications. Hence offers fast recovery, allowing you to return to daily work quickly. TMVR is proven safe and beneficial for patients with degenerated prosthetic valves and in whom repeat surgery is prohibited13. Moreover, this replacement procedure gives long-lasting results compared to valve repair.

    Challenges In TMVR

    TMVR is technically challenging due to the anatomical location and complexity of the mitral valve. Also, it has a risk of obstructing the left ventricular outflow tract and causing embolization2. However, a precise screening process that includes echocardiography, CT imaging, and blood investigations before the intervention, as recommended by your cardiologist, will help you overcome these issues. After the procedure, it is crucial to take prescribed medications and have close follow-ups at regular intervals with your heart specialist.

    Conclusion

    TMVR is an advanced solution for mitral valve defects and allows you to ensure your heart health without invasive open-heart surgery. Consult the best cardiologists in Mumbai to gain optimal outcomes from this life-saving cardiac treatment.

    References

    • Raiten JM, Gutsche JT, Horak J, Augoustides JG. Critical care management of patients following transcatheter aortic valve replacement. F1000Research. 2013;2. doi:10.12688/f1000research.2-62.v1
    • Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet (London, England). 2006;368(9540):1005-1011. doi:10.1016/S0140-6736(06)69208-8
    • Fiorilli PN, Herrmann HC, Szeto WY. Transcatheter mitral valve replacement: latest advances and future directions. Ann Cardiothorac Surg. 2021;10(1):85-95. doi:10.21037/acs-2020-mv-21
    • Coffey S, Cairns BJ, Iung B. The modern epidemiology of heart valve disease. Heart. 2016;102(1):75-85. doi:10.1136/heartjnl-2014-307020
    • Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience. Indian Heart J. 2014;66(3):320-326. doi:10.1016/j.ihj.2014.03.010
    • Backer O De, Piazza N, Banai S, et al. Percutaneous Transcatheter Mitral Valve Replacement. Circ Cardiovasc Interv. 2014;7(3):400-409. doi:10.1161/CIRCINTERVENTIONS.114.001607
    • Duncan A, Daqa A, Yeh J, et al. Transcatheter mitral valve replacement: long-term outcomes of first-in-man experience with an apically tethered device- a case series from a single centre. EuroIntervention J Eur Collab with Work Gr Interv Cardiol Eur Soc Cardiol. 2017;13(9):e1047-e1057. doi:10.4244/EIJ-D-17-00154
    • Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358-1365. doi:10.1093/eurheartj/ehm001
    • Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J cardio-thoracic Surg Off J Eur Assoc Cardio-thoracic Surg. 2012;42(4):S1-44. doi:10.1093/ejcts/ezs455
    • Acker MA, Parides MK, Perrault LP, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23-32. doi:10.1056/NEJMoa1312808
    • Regueiro A, Granada JF, Dagenais F, Rodés-Cabau J. Transcatheter Mitral Valve Replacement: Insights From Early Clinical Experience and Future Challenges. J Am Coll Cardiol. 2017;69(17):2175-2192. doi:https://doi.org/10.1016/j.jacc.2017.02.045
    • Marina U, Dominique H, Eric B, et al. Transseptal Transcatheter Mitral Valve Replacement Using Balloon-Expandable Transcatheter Heart Valves. JACC Cardiovasc Interv. 2017;10(19):1905-1919. doi:10.1016/j.jcin.2017.06.069
    • Webb JG, Murdoch DJ, Boone RH, et al. Percutaneous Transcatheter Mitral Valve Replacement: First-in-Human Experience With a New Transseptal System. J Am Coll Cardiol. 2019;73(11):1239-1246. doi:10.1016/j.jacc.2018.12.065
    • Harloff MT, Chowdhury M, Hirji SA, et al. A step-by-step guide to transseptal valve-in-valve transcatheter mitral valve replacement. Ann Cardiothorac Surg. 2021;10(1):113-121. doi:10.21037/acs-2020-mv-104

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